Provider Demographics
NPI:1326317025
Name:GRANT, RYAN FIELDING (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:FIELDING
Last Name:GRANT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22318 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1657
Mailing Address - Country:US
Mailing Address - Phone:248-486-5216
Mailing Address - Fax:248-486-5460
Practice Address - Street 1:22318 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1657
Practice Address - Country:US
Practice Address - Phone:248-486-5216
Practice Address - Fax:248-486-5460
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist